目的 系统评价网络认知行为疗法(iCBT)对青少年抑郁症状的疗效,以期为临床实践提供参考。方法 网络检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方数据、维普网数据库中iCBT对青少年抑郁症状疗效的随机对照试验(RCT),检索时限为建库至2023年2月,2名研究者独立筛选符合纳入标准的RCTs并提取数据,评价偏倚风险后运用RevMan 5.4.1和R 4.3.0软件的Metafor程序包进行统计分析。结果 共纳入12个RCTs,2 469 例研究对象。Meta分析结果显示:对于干预后抑郁症状评分的组间比较,疗程≤8周,干预组比对照组降低得更多(SMD=-0.63, 95%CI:-0.93~-0.33),差异有统计学意义(P<0.05);疗程>8周,干预组和对照组的变化都不明显(SMD=-0.23, 95%CI:-0.49~0.04),差异无统计学意义(P>0.05);对于长期随访后抑郁症状评分的组间比较,干预组比对照组降低得更多(SMD=-0.28, 95%CI:-0.53~-0.02),差异有统计学意义(P<0.05);干预组长期随访前后的抑郁症状评分变化不明显(SMD=0.13, 95%CI:-0.03~0.29),差异无统计学意义(P>0.05)。结论 iCBT可改善青少年的抑郁症状,且疗效可持续较长时间,建议在临床实践中推广使用。
Abstract
Objective To systematically evaluate the effect of internet-based cognitive behavior therapy(iCBT) for adolescents with depressive symptoms, so as to provide reference for clinical practice. Methods PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang, VIP database were systematically searched to capture relevant randomized controlled trials(RCTs) from database inception to February 2023. Two reviewers independently screened the retrieved literature, then extracted the data and assessed the risk of bias of the eligible RCTs. Statistical analysis was performed by RevMan 5.4.1 and the Metafor package of R 4.3.0 software. Results Twelve RCTs involving 2 469 participants were included. For the intergroup comparison of depressive symptoms score of posttreatment, the intervention group decreased significantly more than the control group(SMD = -0.63, 95% CI:-0.93 - -0.33, P<0.05) when the treatment course ≤ 8 weeks, but the change of intervention group and control group was not significant(SMD=-0.23, 95% CI: -0.49 - 0.04, P>0.05) when the treatment course>8 weeks. For the intergroup comparison of depressive symptoms score of long-term follow-up, the intervention group decreased significantly more than the control group(SMD =-0.28, 95% CI: -0.53 - -0.02, P<0.05). In addition, there were no statistically significant difference when comparing the depressive symptoms scores of the intervention group before and after the long-term follow-up(SMD =0.13, 95% CI: -0.03 - 0.29, P>0.05). Conclusions iCBT can alleviate depressive symptoms in adolescents and the efficacy of iCBT on depressive symptoms can be sustained for a long time. It is recommended to promote iCBT in clinical practice.
关键词
网络 /
认知行为疗法 /
青少年 /
抑郁症状 /
Meta分析
Key words
internet /
cognitive behavior therapy /
adolescent /
depressive symptoms /
Meta-analysis
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基金
国家自然科学基金资助项目(82201691);山西医科大学汾阳学院科技扶持基金(2022C18)
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